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<br /> TO��FNLEDWITH Application for Exemption woRM
<br /> YOUR CpUNTY from MotorVehicleTaxes
<br /> TREASURER by Qualifying Nonprafit Organizations 457
<br /> •Read instructinns on reverse side
<br /> ApplicanYs Name County Type of pwnersh
<br /> ip
<br /> NE SISTERS --- �Nonprafit
<br /> � ------... . HAI'L_._ .
<br /> Street or Other Mailin " _- __._ ......, _.. _..
<br /> g Addres5 County Number Corporation
<br /> 2939 PINNACLE P�INT� DR 40 r,
<br /> .,,- ---. .._ u Other(specify):
<br /> - -.. __ _ _._-- ----... ..._._
<br /> City State Zip Gode Slate Where Incorporated
<br /> GRAND IST,.AIdD NE 6$803 NE
<br /> __ __— _...
<br /> Identify Officer5,Pirectors or Partners
<br /> - _. - Y `....� P....` -- --- -- --
<br /> _..
<br /> T" .J ''' V1Vr�e
<br /> Tdle ame,Address d tate i v
<br /> _
<br /> -- --
<br /> � i(.^f�..5�_ �---� ; ti ���'c�s:+ �. �P t �' �A1� ( ---
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<br /> _.. -- `
<br /> 4._�P �� '�—� �--- .�.�,C(E(� "7 ["l!�_ ��.-e�'V�
<br /> T C�'� �.L)• C�-�-�''" �"f` � -._...
<br /> ---.,... .. .,. _.._..---r
<br /> _..---._._. . _.__.----.__..._
<br /> _........_.,.,...
<br /> �M<�CJ�� � s. � `�����
<br /> � _.. .._.--
<br /> ----._._ __... - — ...---
<br /> LIST SP�CI�'IC DESCRIP710N OF7HE MOTOR VEHICLES
<br /> Attach additinnal sheet if necessary
<br /> _..-- --._ __ _
<br /> Registration Date or Date
<br /> Vehicle Make Model Year eody Type Vehicle Identification Number oi Acquisition ii Newly
<br /> --... --- ----.... __. .._. _
<br /> Purchased
<br /> L _.. C�C.) �v �C%L.. �� �-- ... ---- 2 � - P3`i '3�I.cJ1 b3�t ( �- . .�`��- �-�'ti .Sfr�h�c�
<br /> ---.._.. �.:_��_ ... _ �
<br /> - ---.... ---- i.���_r:,d.
<br /> ---- _ _.__ _.. _
<br /> �v � � o
<br /> --. . _.__.._.---- ---.-----__. _ _ __ . _
<br /> Nature of Llse of Motor Vehicle: Are the motor vehicles used
<br /> ❑Agricultural/Horticultural ❑Educational �Religious L]Charitable ❑Cemetery pxclusively as indicated?
<br /> Give detailed description of use,including an explanation ii multiple classitications exist: I I1E' V P N i C I C' \S , �jC� }YES ❑NO
<br /> � �,�1,r���i�n �.1.�✓� r'��.t Inr11nF ; Vviu ��aCP_ c� Wl,fv��S-Iru �L� ����'ci.
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<br /> C.�C>�'l'`�'�41� C.� i'C � '�A/l L ir . • , a y A . z 7�� re` a
<br /> l� � � �I ,v;�, �r s� d � ,`� �S��r T�e � ��.�� � �
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<br /> V e Y��C.�� �S ��U U`':aC'� -1-C+ ~i V�.....:k__._.. S�C'f e� ��ar�' /"�0�f�S�r��t'
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<br /> �� t"��1 ���l 5 e C� vlr,l r ! - - r�
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<br /> ��z:e� ��C�cyv�e.�.� - �'�nv°;c�t � ��1 l G`a 3
<br /> ----. .__ �.
<br /> Llnder penalties of law,I deciare that 1 have examined this application and,ta the pest of my knowledge d belief,it is cq[1'�c1�rJp�;JpJTY
<br /> complate.l also declare that I am duly authorized to sign this exemption application,and that the organization ow 'ng said propenty�ge�ot;s C�FF!C�
<br /> discriminate in membership ar empioyment based on race,color,or national origin. G�;,\r:J i£''„r;�•a�.:',NF=E�RASKA
<br /> j ` _
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<br /> sign , �,�,�z�: GY--�1._.-!._.--- -- _. . .. _���� I �( ,.� �J f~�r �a;,���-:/�o
<br /> here ,Authorized Signature � `� Title Date
<br /> _. ._..
<br /> FOR COUNTY 7REASURER'S RECOMMENDATION
<br /> �_.....-- -- . -- _. -----.-----
<br /> �PPROVAL 1 CaMMENTS: —.�/�..,��,�.f�--��', ��,����
<br /> �DISAPPROVAL __
<br /> _._ ----- -
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<br /> � .. 'f � � �`-"�:.i� � �L�
<br /> �/� � ..4�. ?:'. / � '�._%'r�`_ " � ,/�.
<br /> � -- - .....,. --... ...... ..
<br /> Sig`n� ature of COUnryTreasUrer � pate
<br /> _... .. �
<br /> �
<br /> FOR COUNTY BOARD OF EQUALIZATI�N U5�QNLY
<br /> []APPROVAL COMMFNTS: .._
<br /> � , � ,r �,;
<br /> �DISAPPROVAL � . ..
<br /> � Y
<br /> __�., � ....__... ;..__ —_.. ,
<br /> _ � - �,���� - __
<br /> _ . � .--
<br /> Authori_ed Signature Date
<br /> y
<br /> --.. _ _ . _._
<br /> Na6raska Departrnant Of Revenuo AulhoYized by Neb Hev.Stat�§77-202(1�(c�(d),§6o•3,185§60•3,789
<br /> 96-253-2DO6 Rev.5-20P9 SupersCdes86-Z53-2UU6 Rav.11-2�08
<br /> PL�ASE MAKE A COPY FOR YOUR RECORDS
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